Understand and deliver
Is the meals-on-wheels service still a caring part of the community or has the drive to cut costs and time reduced it to a clinical delivery operation? Jane Baker looks at why providers are insisting that improved efficiency doesn't have to mean less time to talk.
An average of 60 seconds is spent with the elderly by those who deliver meals on wheels, it was announced at the annual conference of the Advisory Body for Social Services Caterers recently. Dr John Edwards, who carried out the research for Bournemouth University, said of the service: "It's cost-driven… the meals-on-wheels service is genuinely thought of by local authorities as having a social function, but it actually doesn't go further than checking that they are still alive."
Meals-on-wheels providers, such as some local authorities, catering contractors and the Women's Royal Voluntary Service (WRVS), are quick to refute this charge. "I see our role as a caring one and I'd have a problem if our drivers were only allowed a minute to spend with clients," says Jurri Christiaans, regional operations executive with Medirest Social Care.
"For many residents, their only daily contact is the delivery person and, within reason, we give them time. We encourage our drivers to provide a caring service. Many find themselves changing light bulbs, laying the table, co-ordinating shopping deliveries - even dealing with illness and death."
The face of meals on wheels is changing, however, with increased use of vans that heat up frozen meals en route, frozen and chilled meals that can be eaten at chosen times of the day, and a wider range of dishes for the client.
Medirest was the first catering contractor to enter a Private Finance Initiative with a local authority when it signed a contract with the London Borough of Lewisham in 1999. Worth more than £4.3m over 10 years, the contract includes £1m from the community meals sector, where Medirest has just completed a £185,000 investment programme covering refurbishment of kitchens and the launch of a fleet of heated vans called Chefmobils. This replaced a system where meals were cooked in schools and delivered by the authority in hot boxes from standard vans.
These days, meals are bought frozen from Apetito, delivered weekly to a central kitchen and then loaded 60 at a time into the Chefmobils, delivering 800 meals a day. Customers pay £2.30 for one of a choice of 10 hot meals - including traditional or ethnic, such as Afro-Caribbean, halal and kosher - plus four desserts. Described as an "oven on wheels" and developed by Apetito in 1999, the Chefmobil delivers hot meals within two to three hours of leaving the kitchens. The heated van ensures the food is delivered hot and allows more time for the driver to spend with the recipient.
Medirest delivers seven days a week, 365 days of the year, despite weather, bomb scares and, on one occasion, a police cordon, which meant the driver delivering meals on foot. Christiaans says the system is a success. A recent survey of customers showed that more than 88% thought the quality was good. "We felt that buying in meals from Apetito was the best way to maintain quality and produce meals to our own specification," he says.
The London Borough of Sutton, which delivers 700-800 meals a day for £1.70-£2.50 per person, has been using Apetito for more than 12 years, and a frozen-meals service is also proving popular. Roger Denton, catering services manager, says the new service, introduced in response to client demand, is meeting customer needs, but must be treated with caution as it could be used to cut back on delivery times.
"It gives customers a measure of independence, allowing them to choose which meal they eat on what day at what time," he says. "But frail customers wanting frozen meals must be watched, as they might need a hot meal. They also need daily contact. People are living longer, and more suffer from dementia, which can make it tricky. This is why I would not want to see delivery times cut."
Nottinghamshire County Council, serving 2,800 meals a day with a budget of £2.4m, introduced chilled and frozen meals two years ago and now serves 15% frozen and 5% chilled. "It avoids problems of delivering meals too early or too late, as customers can eat them when they like," says Kerry Severn, senior catering officer. "There is also more of a trend in eating the main meal in the evening rather than midday, and we're currently looking at making two hot-meal deliveries a day. But I wouldn't be happy offering a totally frozen-meal service, as I feel that some elderly people need a visit on a daily basis.
"Our drivers are the eyes and the ears of the department. We have 40, each delivering to 56 people over a period of nearly four hours, which allows for 2-3 minutes per visit, which I consider vital."
The WRVS
The Women's Royal Voluntary Service (WRVS) started in 1943 and now boasts more than 100,000 volunteers delivering 10 million meals on wheels a year. Delivery times are not limited to 60 seconds per person as, in many cases, clients may need more help and assistance.
The WRVS has contracts to deliver frozen meals as well as the traditional hot meals and has just taken delivery of its first mobile regeneration van, which heats meals en route. The WRVS also operates a package of intermediate care services, such as home-from-hospital, good-neighbour and transport schemes, to complement meal delivery.
Deliverers undertake a quick "safe and well" check at each visit and may also add value to the service by posting letters and collecting prescriptions, according to George Tait, director of WRVS food services. Yet he admits that the service must change to keep up with customer demand.
"We try to spend as much time as possible with each individual without compromising the obligation WRVS has to deliver meals at the correct temperature within a given time limit," he says.
"We live in a constantly changing environment and the marketplace requires our organisation to be innovative in the way we deliver our services whilst keeping up with the needs of our customers. This helps to reduce social isolation, improve access to services and will reduce overall costs to local authorities and primary care groups. Whilst we have become more commercial in our approach, we have retained the ethos of WRVS - we deliver meals with care."
Apetito
Tel: 0845 6050056
E-mail:info@apetito.co.uk
The meals-on-wheels market is estimated at 800,000 meals per week, of which Apetito has a 45% share, worth about £21m a year. In 1996 Apetito bought Walden Wiltshire Foods, which had been in the meals-on-wheels market since the late 1960s.
While Apetito supplies meals to local authorities, Apetito Services, a division of the company, operates the entire meals-on-wheels contract, providing meals, staff, equipment, IT support and Chefmobils. It also provides the meals and Chefmobils for authorities to operate themselves. The company currently has 120 Chefmobils and operates 12 Chefmobil contracts across the UK.
Total turnover: £42m
Meals served per week: 800,000
Staff: 450
Medirest
Regional operations executive: Jurri Christiaans
London Borough of Lewisham
Total turnover: £4.3m over 10 years
Meals served per day: 800
Staff: 35
London Borough of Sutton
Catering services manager: Roger Denton
Budget: £500,000 a year (estimate)
Meals served per day: 800
Staff: 12
Nottinghamshire County Council
Senior catering officer: Kerry Severn
Budget: £2.4m
Meals served per day: 2,800
